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How a U.K. hospital reduced cardiac arrest rates by one-third

  • Steven Shaha, Ph.D., DBA
  • 12/21/2015

Locally programmable, adaptable Electronic Patient Records (EPRs)* are the most justifiable approach for a host of reasons. It’s the only approach that empowers true collaboration between clinicians and IT professionals. Also, the only approach that can reflect current and newly evolving challenges and concerns clinically or otherwise.

As a result, these EPRs lead to real and sustained improvements in clinical outcomes, such as reducing sepsis and length of stay.  As one clinician said, “If the EPR is not programmable here, then we can’t work together for improvements, and it’s just another black box dictating generic medicine to unthinking, compliant professionals.”

One of the ultimate tests of versatility is to see if an EPR works in “our” unique healthcare environment rather than as a “black box” solution from elsewhere. For example, can an EPR that meets complex U.S. compliance requirements – such as Meaningful Use – also exceed expectations of a hospital in the United Kingdom … or any non-US community?

Concern: Rising complexity of cardiac conditions

A cardiology specialty hospital in the United Kingdom analyzed eight years of data about the number of cardiac arrests occurring among its non-ICU inpatient population. The first three years showed a pretty stable number, rising slowly.

Then the next two years showed the number creeping upward at an alarming rate, reflecting the global trend in health care. No surprise that, as healthcare organizations strive to deliver care in the most cost-effective models and settings, patients are more often tracked toward non-hospital locations. So hospitals today only admit the sickest patients, and the complexity of patient populations keeps increasing year after year.

Statistical analyses predicted a rising frequency for arrests, a trend projected to triple within another two years from the study date. However, instead of just accepting this trend, blaming clinicians, or adding more clinical staff, this hospital determined to reduce arrests through improved clinical care using its EPR.

Solution: Using EPRs and Medical Early Warning System (MEWS) to reduce incidence of cardiac arrest

By clinician design, the EPR was adapted to help clinicians intervene earlier and avoid cardiac arrests when avoidable.  Through Allscripts Sunrise™ they continuously compute and monitor patient risk levels. First, the clinicians in the organization identified the evidence-based characteristics that indicate increased risk, including as heart rate, respiration rate, temperature, blood pressure and relevant lab results. Next, the IT professionals programmed the EPR to continuously compute risk for every patient and advise caregivers correspondingly through the early warning system – commonly labelled as MEWs.

As a result, this hospital successfully reduced arrest rates by 33% in only two years, regaining the levels experienced 4-5 years before. The estimated savings (cash release) is estimated at $144 million for reduced arrest-related interventions and care. As an additional benefit, mortality rates house-wide decreased to 16.7%, reaching rates lower than five years pre-EPR, even though the patient population reflected a more severe case mix.

The hospital has seen the MEWS benefit other clinical areas, with reduced fall rates down 14.1% and falls with injury down 45.7%, and pressure ulcers down more than 50% with zero stage 4.

Of course, a computer or EPR cannot intervene clinically to reduce unfortunate events. But when the computer provides a locally credible MEWs, designed and requested by the clinicians, early warning of impending undesirable outcomes, clinicians are able to intervene more quickly and appropriately on the patient’s behalf.

Customization is more than just changed spelling with “customisation”

This is a great example of how powerful a programmable, adaptable EPR is in the hands of clinicians and IT professionals as a team. And it is as effective in the United Kingdom as it is in the United States, even without identical healthcare models.  When an EPR is this flexible and customizable it can accommodate all kinds of local realities and real differences.

Assuming all healthcare locations and organizations are interchangeable is delusional. Differences reflect organization size, specialty mix and approaches, operational layouts and patient population, to name a few uniquenesses.

With relevant adaptability healthcare organizations can target and improve clinical results with substantive financial benefits and ROI. Bottom line, when it comes to our loved ones we expect better than mere black box medicine, and ours are safer when a programmable, adaptable EPR is available to clinicians.

*Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

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